Hypertriglyceridemia and Intravenous Lipid Titration during Routine Parenteral Nutrition in Small Preterm Infants.

OBJECTIVES In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 ESPGHAN guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR). METHODS We retrospectively reviewed data of preterm infants with a birth weight (BW) <1250 g consecutively admitted to our NICU (2004-2016) who received routine PN. HiTG infants were defined by at least one triglyceride (TG) measurement >250 mg/dL during the first 10 days of life (DOL). Patients with and without HiTG were match-paired for BW and gestational age (GA). RESULTS 658 infants were analysed and 196 (30%) had HiTG. 136 HiTG patients were matched with 136 CNTR. In the first 10 DOL, IV lipid, non-protein energy (NPE) and total energy intakes, but not IV amino acids (AA) and carbohydrates (CHO), were significantly lower in HiTG infants. We found no differences between groups in diseases associated with prematurity. Anthropometry at 36 weeks (W), anthropometry at 2-year (Y) corrected age (CA), and neurodevelopment at 2Y CA were not different. CONCLUSIONS Growth, diseases associated with prematurity and neurodevelopment at 2Y CA in HiTG infants were similar to CNTR. This occurred despite a statistically significant albeit small reduction in IV lipid and NPE intakes due to a strict TG monitoring and IV lipid titration at TG levels >250 mg/dL.